Instrument for endoscopic posterior nasal nerve ablation

ABSTRACT

A surgical instrument includes an elongate shaft having a proximal shaft portion and a malleable distal shaft portion. The elongate shaft is configured to be secured to a supporting surgical instrument. An ablation head is coupled to the malleable distal shaft portion and includes at least one electrode operable to deliver RF energy to tissue for ablating the tissue. The ablation head is sized to fit within the nasal cavity of a patient with a distal end of the supporting surgical instrument. The proximal shaft portion is configured to operatively couple with an RF energy source operable to energize the at least one electrode with RF energy. The malleable distal shaft portion is configured to bend relative to a longitudinal shaft axis defined by the proximal shaft portion for selectively orienting the ablation head relative to the longitudinal shaft axis.

PRIORITY

This application is a continuation of U.S. patent application Ser. No.16/783,626, filed Feb. 6, 2020, published as U.S. Pub. No. 2020/0261149on Aug. 20, 2020, which claims the benefit of U.S. Provisional Pat. App.No. 62/806,009, entitled “Instrument for Endoscopic Posterior NasalNerve Ablation,” filed Feb. 15, 2019, the disclosures of which areincorporated by reference herein.

BACKGROUND

Rhinitis is a medical condition that presents as irritation andinflammation of the mucous membrane within the nasal cavity. Theinflammation results in the generation of excessive amounts of mucus,which can cause runny nose, nasal congestion, sneezing, and/orpost-nasal drip. Allergenic rhinitis is an allergic reaction toenvironmental factors such as airborne allergens, while non-allergenic(or “vasomotor”) rhinitis is a chronic condition that presentsindependently of environmental factors. Conventional treatments forrhinitis include antihistamines, topical or systemic corticosteroids,and topical anticholinergics, for example.

For cases of intractable rhinitis in which the symptoms are severe andpersistent, an additional treatment option is the surgical removal of aportion of the vidian (or “pterygoid”) nerve—a procedure known as vidianneurectomy. The theoretical basis for vidian neurectomy is that rhinitisis caused by an imbalance between parasympathetic and sympatheticinnervation of the nasal cavity, and the resultant over stimulation ofmucous glands of the mucous membrane. Vidian neurectomy aims to disruptthis imbalance and reduce nasal mucus secretions via surgical treatmentof the vidian nerve. However, in some instances, vidian neurectomy cancause collateral damage to the lacrimal gland, which is innervated bythe vidian nerve. Such damage to the lacrimal gland may result inlong-term health complications for the patient, such as chronic dry eye.Posterior nasal neurectomy, or surgical removal of a portion of theposterior nasal nerves, may be an effective alternative to vidianneurectomy for treating intractable rhinitis.

FIG. 1 depicts a left sagittal view of a portion of a patient's head,showing the nasal cavity (10), the frontal sinus (12), the sphenoidsinus (14), and the sphenoid bone (16). The nasal cavity (10) is boundedlaterally by the nasal wall (18), which includes an inferior turbinate(20), a middle turbinate (22), and a superior turbinate (24). The vidiannerve (32) resides within the vidian (or “pterygoid”) canal (30), whichis defined in part by the sphenoid bone (16) and is located posterior tothe sphenoid sinus (14), approximately in alignment with the middleturbinate (22). The vidian nerve (32) is formed at its posterior end bythe junction of the greater petrosal nerve (34) and the deep petrosalnerve (36); and joins at its anterior end with the pterygopalatineganglion (38), which is responsible for regulating blood flow to thenasal mucosa. The posterior nasal nerves (40) join with thepterygopalatine ganglion (38) and extend through the region surroundingthe inferior turbinate (20).

While instruments and methods for performing vidian neurectomies andposterior nasal neurectomies are known, it is believed that no one priorto the inventors has made or used the invention described in theappended claims.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate embodiments of the invention,and, together with the general description of the invention given above,and the detailed description of the embodiments given below, serve toexplain the principles of the present invention.

FIG. 1 depicts a left sagittal view of a portion of a patient's head,showing details of certain paranasal sinuses and nerves, including thevidian nerve and the posterior nasal nerve;

FIG. 2 depicts a schematic perspective view of an exemplary surgicalsystem that includes a surgical instrument assembly defined by anendoscope and an RF ablation instrument in combination, and an RF energysource coupled with the RF ablation instrument;

FIG. 3 depicts a perspective view of the RF ablation instrument of FIG.2 ;

FIG. 4 depicts a cross-sectional view of the RF ablation instrument ofFIG. 2 , taken along section line 4-4 in FIG. 3 ;

FIG. 5 depicts an enlarged perspective view of a distal portion of thesurgical instrument assembly of FIG. 2 ;

FIG. 6 depicts a right sagittal view of a portion of a patient's headwith portions of a nasal wall shown broken away to reveal underlyingnerves, showing an exemplary method for ablating a posterior nasal nerveof the patient at a treatment site within the nasal cavity with RFenergy provided by the surgical system of FIG. 2 ;

FIG. 7A depicts an enlarged schematic view of the treatment site of FIG.6 , showing an ablation head of the RF ablation instrument of FIG. 2being applied to nasal wall tissue at the treatment site for ablating aposterior nasal nerve residing beneath the tissue in accordance with themethod of FIG. 6 ; and

FIG. 7B depicts an enlarged schematic view of the treatment site of FIG.6 , showing a portion of the posterior nasal nerve after having beenablated by the application of RF energy as shown in FIG. 7A.

The drawings are not intended to be limiting in any way, and it iscontemplated that various embodiments of the invention may be carriedout in a variety of other ways, including those not necessarily depictedin the drawings. The accompanying drawings incorporated in and forming apart of the specification illustrate several aspects of the presentinvention, and together with the description serve to explain theprinciples of the invention; it being understood, however, that thisinvention is not limited to the precise arrangements shown.

DETAILED DESCRIPTION

The following description of certain examples of the invention shouldnot be used to limit the scope of the present invention. Other examples,features, aspects, embodiments, and advantages of the invention willbecome apparent to those skilled in the art from the followingdescription, which is by way of illustration, one of the best modescontemplated for carrying out the invention. As will be realized, theinvention is capable of other different and obvious aspects, all withoutdeparting from the invention. Accordingly, the drawings and descriptionsshould be regarded as illustrative in nature and not restrictive.

For clarity of disclosure, the terms “proximal” and “distal” are definedherein relative to a surgeon, or other operator, grasping a surgicalinstrument having a distal surgical end effector. The term “proximal”refers to the position of an element arranged closer to the surgeon, andthe term “distal” refers to the position of an element arranged closerto the surgical end effector of the surgical instrument and further awayfrom the surgeon. Moreover, to the extent that spatial terms such as“top,” “bottom,” “upper,” “lower,” “vertical,” “horizontal,” or the likeare used herein with reference to the drawings, it will be appreciatedthat such terms are used for exemplary description purposes only and arenot intended to be limiting or absolute. In that regard, it will beunderstood that surgical instruments such as those disclosed herein maybe used in a variety of orientations and positions not limited to thoseshown and described herein.

As used herein, the terms “about,” “approximately,” and the like inconnection with any numerical values or ranges of values are intended toencompass the exact value(s) referenced, as well as a suitabledimensional tolerance that enables the referenced feature or combinationof features to function for the intended purpose described herein.

I. Overview of Exemplary RF Ablation Surgical System

FIG. 2 shows an exemplary RF ablation surgical system (100) operable toablate a nerve, such as the posterior nasal neve (40), within the nasalcavity (10) of a patient with radio frequency (RF) energy. Surgicalsystem (100) comprises a surgical instrument assembly (110) defined by asupporting surgical instrument in the form of an endoscope (120), and anRF ablation instrument (140) secured to an elongate rigid shaft (124) ofendoscope (120). RF ablation instrument (140) is coupled with an RFgenerator (170) operable to deliver RF energy to an ablation head (150)of RF ablation instrument (140) for ablating tissue positioned incontact with ablation head (150), as described in greater detail below.

Endoscope (120) of the present example includes a body (122) that mayfunction as a handle, and an elongate, rigid shaft (124) extendingdistally from body (122) along a central longitudinal axis (A1) (seeFIG. 5 ), Endoscope shaft (124) is sized to be received within variousanatomical passages of the human body, such as the ear, nose, andthroat, for example. In one exemplary version, endoscope shaft (124) mayhave an outer diameter of approximately 4 mm and a working length ofapproximately 175 mm. A distal end of endoscope shaft (124) includes awindow (126) through which an endoscopic image is captured in a field ofview (FOY). Though not shown, the distal end of endoscope shaft (124)may house a moveable optical element in the form of a swing prismoperable to provide endoscope (120) with a moveable field of view (FOV)through window (126), thereby enabling viewing along a variety oftransverse viewing angles without having to flex endoscope shaft (124)within the anatomical passageway. Such a swing prism and relatedfeatures of endoscope (120) may be configured in accordance with theteachings of U.S. Pat. Pub. No. 2010/0030031, entitled “Swing PrismEndoscope,” published Feb. 4, 2010, the disclosure of which isincorporated by reference herein. Alternatively, endoscope (120) maytake any other suitable form as will be apparent to those skilled in theart in view of the teachings herein.

To adjust the field of view (FOV) of endoscope (120), endoscope shaft(124) is selectively rotatable relative to body (122) about the centrallongitudinal axis (A1), and the swing prism (not shown) housed withinthe distal end of endoscope shaft (124) is selectively movable relativeto endoscope shaft (124). To provide such adjustment, endoscope body(122) includes a distal dial (128) that is selectively rotatable aboutthe central longitudinal axis (A1) of endoscope (120) to rotateendoscope shaft (124) relative to body (122) about the centrallongitudinal axis (A1). Body (122) further includes a proximal dial(130) that is selectively rotatable about the central longitudinal axis(A1) to pivot the swing prism (not shown) within and relative toendoscope shaft (124). Accordingly, selective actuation of dials (128,130) enables an operator to move the field of view (FOV) of endoscope(120) to thereby visualize a particular anatomical region of interestwithin a patient during a procedure without having to flex endoscopeshaft (124).

RF ablation instrument (140) is configured to be fixedly secured to andsupported by rigid shaft (124) of endoscope (120) such that ablationhead (150) is positioned with the field of view (FOV) of endoscope(120). Accordingly, an operator may visualize via endoscope (120) anablation procedure being performed with RF ablation instrument (140), asdescribed in greater detail below. As shown best in FIG. 3 , RF ablationinstrument (140) of the present example includes an elongate shaft (142)having a proximal shaft portion (144) and a distal shaft portion (146).At least distal shaft portion (146) is formed of a malleable material,such as nickel-titanium alloy (or “Nitinol”), such that distal shaftportion (146) is configured to bend relative to a longitudinal axisdefined by proximal shaft portion (144). In some instances, an entiretyof elongate shaft (142) may be formed of a malleable material such thatshaft (142) may be bent to assume a variety of configurations as desiredby an operator. As used herein in connection with elongate shaft (142)of RF ablation instrument (140), the terms “bend,” “bent,” andvariations thereof mean plastic deformation in which the referencedportion of shaft (142) retains the shape to which it is formed by theoperator.

As shown in FIG. 5 , ablation head (150) extends distally from a distalend of distal shaft portion (146) of RF ablation instrument (140).Ablation head (150) of the present example is generally rectangular inshape but may be formed with a variety of other suitable shapes in otherexamples. A planar lower surface (152) of ablation head (150) supports apair of electrodes (154, 156) positioned adjacent to one another. Asdescribed in greater detail below in connection with FIGS. 6-7B,electrodes (154, 156) are configured to cooperate to deliver bipolar RFenergy to tissue (e.g., a nerve) positioned in contact with bothelectrodes (154, 156), to thereby ablate the tissue with RF energy.Electrodes (154, 156) of the present version are generally rectangularin shape and equal in size. In other versions, various other quantities,shapes, and arrangements of electrodes may be provided on ablation head(150) for ablating tissue with RF energy.

In some versions, ablation head (150) may include a single electrodeconfigured to deliver monopolar RF energy to tissue positioned incontact with the electrode, in combination with a ground pad (not shown)positioned in contact with the patient's skin. Accordingly, it will beappreciated that ablation head (150) may be suitably configured todeliver bipolar or monopolar RF energy to tissue based on the selectedsurgical application. For instance, in surgical applications in whichmore localized treatment of tissue is desired, ablation head (150) maybe configured with two or more electrodes (154, 156) operable to treattissue with bipolar RF energy. For other surgical applicationswarranting a deeper treatment of the targeted tissue, ablation head(150) may be configured with a single RF electrode operable to treattissue with monopolar RF energy. Furthermore, in addition to or in lieuof one or more RF ablation electrodes, ablation head (150) may include aresistance heating device, a cryoablation applicator, a chemicalapplicator, and/or an optical energy transmission device operable toablate tissue.

In other examples, ablation head (150) may further comprise one or moretissue sensors operable to sense a condition of the tissue (e.g., anerve) being ablated by electrodes (154, 156). Each such sensor maycommunicate a signal to a processor (not shown) of surgical system (100)indicating the sensed condition. In response to receiving the signal,the system processor may then regulate (e.g., deactivate) the RFablation energy being delivered to electrodes (154, 156) from RFgenerator (170), and/or provide an indication to the operator informingof the sensed tissue condition. In some versions, ablation head (150)may include a tissue sensor in the form of a thermocouple (not shown)operable to measure a temperature of the tissue during ablation. In suchversions, the system processor may deactivate delivery of RF ablationenergy to electrodes upon determining that the sensed tissue temperaturehas reached a threshold temperature.

In other versions, ablation head (150) may include a tissue sensor inthe form of a pair of detection electrodes operable to deliver a lowpower RF signal to the target tissue to measure an electrical impedanceof the tissue during ablation. In some such versions, such detectionelectrodes may be provided separately from electrodes (154, 156) ofablatio head (150). In other such versions, electrodes (154, 156) may beoperable as both ablation electrodes and as detection electrodes. Ineither configuration, the low power RF signal may be delivered to thetarget tissue simultaneously or in rapidly alternating fashion with thehigh-power RF ablation energy delivered by electrodes (154, 156). Whilethe target tissue remains substantially intact and unablated, the lowpower RF signal will pass freely through the tissue with a relativelylow impedance. As ablation of the tissue progresses, the detectionelectrodes will detect an increase in impedance of the tissue, which iscommunicated to the system processor.

As shown in FIG. 2 , RF ablation instrument (140) further includes aproximal electrical connector (160) coupled with proximal shaft portion(144) by a cable (162). As shown schematically, proximal electricalconnector (160) is configured to releasably couple with a separate cable(172), or another coupling device, that places RF ablation instrument(140) in electric communication with RF generator (170) so that RFgenerator (170) may deliver RF energy to electrodes (154, 156) ofablation head (150).

As shown in FIG. 4 , elongate shaft (142) of the present example housesan electrically conductive wire (148) that electrically coupleselectrodes (154, 156) of ablation head (150) with proximal electricalconnector (160), such that RF energy may be transferred from RFgenerator (170) to electrodes (154, 156), via connector (160), cable(162), and wire (148). Though not shown, wire (148) and/or elongateshaft (142) itself may be shielded with a non-conductive material toprevent electrical shorting of RF ablation instrument (140) throughelongate shaft (142), particularly in instances in which elongate shaft(142) itself is formed of an electrically conductive material. In someother versions of RF ablation instrument (140), wire (148) may beomitted and elongate shaft (142) (and optionally also ablation head(150)) may be formed of an electrically conductive material thatelectrically couples electrodes (154, 156) with proximal electricalconnector (160). In such versions, elongate shaft (142) (and ablationhead (150)) may be shielded with a non-conductive material to preventelectrical shorting of RF ablation instrument (140). Moreover, in suchversions, electrodes (154, 156) may be defined by the same structurethat defines ablation head (150).

As shown in FIGS. 2 and 5 , and as discussed above, elongate shaft (142)of RF ablation instrument (140) is configured to be fixedly secured torigid shaft of endoscope (120) such that ablation head (150) ispositioned within the field of view (FOV) of endoscope (120). Suchsecurement may be achieved with a variety of suitable methods that willbe readily apparent to those of ordinary skill in the art. For instance,ablation instrument shaft (142) may be secured to endoscope shaft (124)with an adhesive or with heat shrink tubing, for example, thus providingthe resulting instrument assembly (110) with a minimal outer diameter.Furthermore, ablation instrument shaft (142) may be secured to endoscopeshaft (124) such that proximal shaft portion (144) of ablationinstrument shaft (142) extends parallel to endoscope shaft (124).

As shown in FIG. 5 , ablation head (150) extends distally from distalshaft portion (146) of RF ablation instrument (140) along a head axis(A2). The malleability of at least distal shaft portion (146) enablesablation head (150) to be selectively oriented by an operator such thathead axis (A2) is offset from endoscope axis (A1), yet still parallel toendoscope axis (A1). In the configuration shown, ablation head (150) isoriented such that the electrode-supporting lower surface (152) ofablation head (150) faces away from endoscope window (126), and anopposed upper surface of ablation head (150) (not shown) faces towardendoscope window (126). As indicated by the directional arrows shown inFIGS. 3 and 5 , distal shaft portion (146) may be bent by an operator toachieve any desired orientation of ablation head (150) relative to theproximal shaft portion (144) and the distal end of endoscope shaft(124). In this manner, ablation head (150) may be suitably positionedwithin the field of view (FOV) of endoscope (120) while maintaining asuitable lateral spacing from endoscope window (126) to enable effectiveRF ablation treatment while accommodating patient anatomy at thesurgical site (e.g., within nasal cavity (10)).

Though not shown herein, RF ablation instrument (140) may be combinedwith features of an image-guided surgery (IGS) navigation system tofurther facilitate positioning of ablation head (150) within a patient.By way of example, such an IGS navigation system may be constructed andoperable in accordance with at least some of the teachings of U.S. Pat.No. 7,720,521, entitled “Methods and Devices for Performing Procedureswithin the Ear, Nose, Throat and Paranasal Sinuses,” issued May 18,2010, the disclosure of which is incorporated by reference herein;and/or U.S. Pat. Pub. No. 2014/0364725, entitled “Systems and Methodsfor Performing Image Guided Procedures within the Ear, Nose, Throat andParanasal Sinuses,” published Dec. 11, 2014, the disclosure of which isincorporated by reference herein.

II. Exemplary Method of Ablating Posterior Nasal Nerve

Having described exemplary features of RF ablation surgical system (100)above, an exemplary method of performing a neurectomy on a posteriornasal nerve (40) of a patient with system (100) will now be described inconnection with FIGS. 6-7B. While surgical system (100) is shown anddescribed for treating a posterior nasal nerve, it will be appreciatedthat surgical system (100) may be employed in various other surgicalapplications for ablating other nerves within the nasal cavity (10), orfor ablating tissues in various other anatomical regions of a patient.For instance, the teachings herein may be combined with at least some ofthe teachings of U.S. Pat. Pub. No. 2019/0374280, entitled “Apparatusand Method for Performing Vidian Neurectomy Procedure,” published Dec.12, 2019, the disclosure of which is incorporated by reference herein.

Before insertion of the distal end of instrument assembly (110) into thepatient, distal shaft portion (146) of RF ablation instrument (140) ismanually bent by the operator as needed to position ablation head (150)within the field of view (FOV) of endoscope (120). In the presentexample, distal shaft portion (146) (and optionally also a portion ofproximal shaft portion (144)) is suitably bent such that ablation head(150) is offset from proximal shaft portion (144) and endoscope shaft(124), and such that electrodes (154, 156) face away from endoscopewindow (126), as described above in connection with FIG. 5 .

The distal end of instrument assembly (110) is then inserted into thenasal cavity (10) of the patient and advanced toward a treatment site(TS) at the posterior ends of the inferior and middle turbinates (20,22), under visualization provided by endoscope (120). While advancingtoward the treatment site (TS), the operator manipulates endoscope (120)as needed to position electrodes (154, 156) of ablation head (150) incontact with the portion of nasal wall (18) in which the targetposterior nasal nerve (40) resides. For instance, the operator mayselectively rotate distal dial (128) of endoscope (120) to therebyrotate endoscope shaft (124) and thus RF ablation instrument (140) aboutthe central endoscope axis (A1) to better position ablation head (150)relative to the posterior nasal nerve (40) at the treatment site (TS).Because ablation head (150) remains within the endoscope field of view(FOV) throughout this process, the operator is able to maintainvisualization of ablation head (150) and thereby ensure accurateplacement of ablation head (150) relative to the treatment site (TS). Itwill be appreciated that malleable distal shaft portion (146) of RFablation instrument (140) may be provided with sufficient rigidity toresist unintended bending when ablation head (150) is pressed againstnasal wall (18) with the minimum force necessary to maintain directcontact of electrodes (154, 156) with the nasal wall tissue to enabledelivery of RF ablation energy.

As shown in FIG. 7A, endoscope (120) is suitably manipulated to positionablation head (150) against the portion of nasal wall (18) that overliesthe target posterior nasal nerve (40) at the treatment site (TS).Ablation head electrodes (154, 156) are then activated to deliverbipolar RF energy to nerve (40), through nasal wall (18), to therebyablate the nerve (40). When full ablation of the nerve (40) is achieved,which may be determined via one or tissue sensors as described above,ablation head (150) is removed from contact with nasal wall (18) andinstrument assembly (110) is retracted from the nasal cavity (10),leaving the posterior nasal nerve (40) in the ablated state shown inFIG. 7B. Advantageously, such a neurectomy of the posterior nasal nerve(40) via RF ablation is effective to treat intractable cases of rhinitisin a patient without damaging the patient's lacrimal gland and causingassociated adverse health conditions, such as dry eye.

Following the surgical procedure, RF ablation instrument (140) may beseparated from endoscope shaft (124) and disposed of; and replaced witha fresh RF ablation instrument (140) for a subsequent surgicalprocedure. In other examples, RF ablation instrument (140) may beconfigured to undergo sterilization along with endoscope (120), suchthat RF ablation instrument (140) may be reused multiple times.

III. Exemplary Combinations

The following examples relate to various non-exhaustive ways in whichthe teachings herein may be combined or applied. It should be understoodthat the following examples are not intended to restrict the coverage ofany claims that may be presented at any time in this application or insubsequent filings of this application. No disclaimer is intended. Thefollowing examples are being provided for nothing more than merelyillustrative purposes. It is contemplated that the various teachingsherein may be arranged and applied in numerous other ways. It is alsocontemplated that some variations may omit certain features referred toin the below examples. Therefore, none of the aspects or featuresreferred to below should be deemed critical unless otherwise explicitlyindicated as such at a later date by the inventors or by a successor ininterest to the inventors. If any claims are presented in thisapplication or in subsequent filings related to this application thatinclude additional features beyond those referred to below, thoseadditional features shall not be presumed to have been added for anyreason relating to patentability.

Example 1

A surgical instrument comprising: (a) an elongate shaft having aproximal shaft portion and a malleable distal shaft portion, wherein theelongate shaft is configured to be secured to a supporting surgicalinstrument; and (b) an ablation head coupled to the malleable distalshaft portion, wherein the ablation head includes at least one electrodeoperable to deliver RF energy to tissue for ablating the tissue, whereinthe ablation head is sized to fit within the nasal cavity of a patientwith a distal end of the supporting surgical instrument, wherein theproximal shaft portion is configured to operatively couple with an RFenergy source operable to energize the at least one electrode with RFenergy, wherein the malleable distal shaft portion is configured to bendrelative to a longitudinal shaft axis defined by the proximal shaftportion for selectively orienting the ablation head relative to thelongitudinal shaft axis.

Example 2

The surgical instrument of Example 1, wherein the at least one electrodecomprises first and second electrodes operable to deliver bipolar RFenergy to tissue.

Example 3

The surgical instrument of any of the preceding Examples, wherein theablation head defines a distal end of the RF ablation instrument.

Example 4

The surgical instrument of any of the preceding Examples, wherein theablation head extends distally from the malleable distal shaft portionalong a head axis, wherein the malleable distal shaft portion isconfigured to bend relative to the longitudinal shaft axis to orient theablation head in a position in which the head axis is offset from andparallel to the longitudinal shaft axis.

Example 5

The surgical instrument of any of the preceding Examples, wherein theablation head comprises a planar surface, wherein the at least oneelectrode is disposed on the planar surface.

Example 6

The surgical instrument of any of the preceding Examples, wherein theablation head is rectangular.

Example 7

The surgical instrument of any of the preceding Examples, furthercomprising an electrical conductor housed within the elongate shaft,wherein the electrical conductor is configured to electrically couplethe at least one electrode of the ablation head with the RF energysource.

Example 8

The surgical instrument of any of the preceding Examples, wherein theelongate shaft comprises an electrically conductive material configuredto electrically couple the at least one electrode of the ablation headwith the RF energy source.

Example 9

The surgical instrument of any of the preceding Examples, furthercomprising an electrical connector coupled with the proximal shaftportion, wherein the electrical connector is configured to releasablycouple with the RF energy source to place the at least one electrode inelectric communication with the RF energy source.

Example 10

A surgical instrument assembly comprising: (a) an endoscope, wherein theendoscope comprises: (i) an endoscope shaft, and (ii) a distal endthrough which the endoscope is configured to capture an image of patientanatomy; and (b) the surgical instrument of any of the precedingExamples, wherein the proximal shaft portion of the surgical instrumentis secured relative to the endoscope shaft.

Example 11

The surgical instrument assembly of Example 10, wherein the ablationhead is configured to be positioned within a field of view of the distalend of the endoscope.

Example 12

The surgical instrument assembly of any of Examples 10 through 11,wherein the proximal shaft portion of the surgical instrument extendsparallel to the endoscope shaft.

Example 13

The surgical instrument assembly of any of Examples 10 through 12,wherein the proximal shaft portion of the surgical instrument is incontact with the endoscope shaft, wherein the ablation head isconfigured to assume a position in which the ablation head is spacedapart from the endoscope shaft.

Example 14

The surgical instrument assembly of any of Examples 10 through 13,wherein the ablation head includes a first surface that faces toward theendoscope shaft and an opposed second surface that faces away from theendoscope shaft, wherein the at least one electrode is disposed on thesecond surface.

Example 15

The surgical instrument assembly of any of Examples 10 through 14,wherein the endoscope further comprises a handle from which theendoscope shaft extends distally, wherein the endoscope shaft and thesurgical instrument are rotatable together relative to the handle abouta longitudinal axis defined by the endoscope shaft.

Example 16

A surgical instrument assembly comprising: (a) an endoscope, wherein theendoscope includes an elongate shaft having a distal shaft end throughwhich the endoscope is configured to capture an image of patientanatomy; and (b) an RF ablation instrument secured relative to theelongate shaft of the endoscope, wherein the RF ablation instrumentcomprises: (i) a malleable shaft portion, and (ii) an ablation headsecured to a distal end of the malleable shaft portion, wherein theablation head includes at least one electrode operable to ablate patienttissue with RF energy, wherein the ablation head is sized to fit withinthe nasal cavity of a patient, wherein the malleable shaft portion isconfigured to bend for selectively orienting the ablation head relativeto the distal shaft end of the endoscope.

Example 17

The surgical instrument assembly of Example 16, wherein the at least oneelectrode comprises first and second electrodes operable to deliverbipolar RF energy to tissue.

Example 18

The surgical instrument assembly of any of Examples 16 through 17,wherein a proximal end of the RF ablation instrument includes anelectrical connector configured to releasably couple with an RF energysource operable to deliver RF energy to the at least one electrode.

Example 19

A method of ablating a posterior nasal nerve of a patient with asurgical instrument assembly comprising an endoscope and an RF ablationinstrument, wherein the endoscope includes a distal end configured tocapture an image of patient anatomy, wherein the RF ablation instrumentis secured to the endoscope and includes a malleable shaft portion andan ablation head having an electrode, the method comprising: (a) bendingthe malleable shaft portion of the RF ablation instrument to positionthe ablation head within a field of view of the distal end of theendoscope; (b) inserting the distal end of the endoscope and theablation head into a nasal cavity of a patient; (c) under visualizationprovided by the endoscope, positioning the electrode of the ablationhead in electrical contact with tissue overlying a posterior nasal nerveof the patient; and (d) energizing the electrode with RF energy tothereby ablate a portion of the posterior nasal nerve with the RFenergy.

Example 20

The method of Example 19, wherein the ablation head includes first andsecond electrodes, wherein ablating the posterior nasal nerve with RFenergy comprises positioning the first and second electrodes inelectrical contact with the tissue overlying the posterior nasal nerveand delivering bipolar RF energy to the tissue.

IV. Miscellaneous

It should be understood that any one or more of the teachings,expressions, embodiments, examples, etc. described herein may becombined with any one or more of the other teachings, expressions,embodiments, examples, etc. that are described herein. Theabove-described teachings, expressions, embodiments, examples, etc.should therefore not be viewed in isolation relative to each other.Various suitable ways in which the teachings herein may be combined willbe readily apparent to those of ordinary skill in the art in view of theteachings herein. Such modifications and variations are intended to beincluded within the scope of the claims.

It should be appreciated that any patent, publication, or otherdisclosure material, in whole or in part, that is said to beincorporated by reference herein is incorporated herein only to theextent that the incorporated material does not conflict with existingdefinitions, statements, or other disclosure material set forth in thisdisclosure. As such, and to the extent necessary, the disclosure asexplicitly set forth herein supersedes any conflicting materialincorporated herein by reference. Any material, or portion thereof, thatis said to be incorporated by reference herein, but which conflicts withexisting definitions, statements, or other disclosure material set forthherein will only be incorporated to the extent that no conflict arisesbetween that incorporated material and the existing disclosure material.

Versions of the devices described above may have application inconventional medical treatments and procedures conducted by a medicalprofessional, as well as application in robotic-assisted medicaltreatments and procedures. By way of example only, various teachingsherein may be readily incorporated into a robotic surgical system suchas the DAVINCI™ system by Intuitive Surgical, Inc., of Sunnyvale,California. Similarly, those of ordinary skill in the art will recognizethat various teachings herein may be readily combined with variousteachings of any of the following: U.S. Pat. No. 5,792,135, entitled“Articulated Surgical Instrument For Performing Minimally InvasiveSurgery With Enhanced Dexterity and Sensitivity,” issued Aug. 11, 1998,the disclosure of which is incorporated by reference herein; U.S. Pat.No. 8,783,541, entitled “Robotically-Controlled Surgical End EffectorSystem,” issued Jul. 22, 2014, the disclosure of which is incorporatedby reference herein; U.S. Pat. No. 8,479,969, entitled “Drive Interfacefor Operably Coupling a Manipulatable Surgical Tool to a Robot,” issuedJul. 9, 2013; U.S. Pat. No. 8,800,838, entitled “Robotically-ControlledCable-Based Surgical End Effectors,” issued Aug. 12, 2014, thedisclosure of which is incorporated by reference herein; and/or U.S.Pat. No. 8,573,465, entitled “Robotically-Controlled Surgical EndEffector System with Rotary Actuated Closure Systems,” issued Nov. 5,2013, the disclosure of which is incorporated by reference herein.

Versions of the devices described above may be designed to be disposedof after a single use, or they can be designed to be used multipletimes. Versions may, in either or both cases, be reconditioned for reuseafter at least one use. Reconditioning may include any combination ofthe steps of disassembly of the device, followed by cleaning orreplacement of particular pieces, and subsequent reassembly. Inparticular, some versions of the device may be disassembled, and anynumber of the particular pieces or parts of the device may beselectively replaced or removed in any combination. Upon cleaning and/orreplacement of particular parts, some versions of the device may bereassembled for subsequent use either at a reconditioning facility, orby a user immediately prior to a procedure. Those skilled in the artwill appreciate that reconditioning of a device may utilize a variety oftechniques for disassembly, cleaning/replacement, and reassembly. Use ofsuch techniques, and the resulting reconditioned device, are all withinthe scope of the present application.

By way of example only, versions described herein may be sterilizedbefore and/or after a procedure. In one sterilization technique, thedevice is placed in a closed and sealed container, such as a plastic orTYVEK bag. The container and device may then be placed in a field ofradiation that can penetrate the container, such as gamma radiation,x-rays, or high-energy electrons. The radiation may kill bacteria on thedevice and in the container. The sterilized device may then be stored inthe sterile container for later use. A device may also be sterilizedusing any other technique known in the art, including but not limited tobeta or gamma radiation, ethylene oxide, or steam.

Having shown and described various embodiments of the present invention,further adaptations of the methods and systems described herein may beaccomplished by appropriate modifications by one of ordinary skill inthe art without departing from the scope of the present invention.Several of such potential modifications have been mentioned, and otherswill be apparent to those skilled in the art. For instance, theexamples, embodiments, geometrics, materials, dimensions, ratios, steps,and the like discussed above are illustrative and are not required.Accordingly, the scope of the present invention should be considered interms of the following claims and is understood not to be limited to thedetails of structure and operation shown and described in thespecification and drawings.

1-20. (canceled)
 21. A surgical instrument assembly comprising: (a) anendoscope, the endoscope including an elongate shaft defining alongitudinal axis and having a distal end, the endoscope having a windowwith a field of view, the field of view including a region proximal tothe distal end; and (b) a surgical instrument comprising: (i) anelongate shaft having a malleable distal portion, a proximal region ofthe malleable distal portion being fixed against longitudinal movementrelative to the endoscope; and (ii) an ablation head coupled to themalleable distal portion, the ablation head including at least oneelectrode operable to deliver energy to tissue for ablating the tissue.22. The surgical instrument of claim 21, the at least one electrodecomprising first and second electrodes operable to deliver bipolar RFenergy to tissue.
 23. The surgical instrument of claim 21, the ablationhead defining a distal end of an ablation instrument.
 24. The surgicalinstrument of claim 21, the ablation head extending distally from themalleable distal portion along a head axis, the malleable distal portionbeing configured to bend relative to the longitudinal shaft axis toorient the ablation head in a position in which the head axis is offsetfrom and parallel to the longitudinal shaft axis.
 25. The surgicalinstrument of claim 21, the ablation head comprising a planar surface,the at least one electrode being disposed on the planar surface.
 26. Thesurgical instrument of claim 21, the ablation head being rectangular.27. The surgical instrument of claim 21, further comprising anelectrical conductor housed within the elongate shaft, the electricalconductor being configured to electrically couple the at least oneelectrode of the ablation head with an energy source.
 28. The surgicalinstrument of claim 21, the elongate shaft comprising an electricallyconductive material configured to electrically couple the at least oneelectrode of the ablation head with an energy source.
 29. The surgicalinstrument of claim 21, further comprising an electrical connectorcoupled with a proximal portion of the elongate shaft of the surgicalinstrument, the electrical connector being configured to releasablycouple with an energy source to place the at least one electrode inelectric communication with the energy source.
 30. The surgicalinstrument assembly of claim 21, the ablation head being configured tobe positioned within the field of view.
 31. The surgical instrumentassembly of claim 21, a proximal portion of the elongate shaft of thesurgical instrument extending parallel to the elongate shaft of theendoscope.
 32. The surgical instrument assembly of claim 21, a proximalportion of the elongate shaft of the surgical instrument being incontact with the elongate shaft of the endoscope, the ablation headbeing configured to assume a position in which the ablation head isspaced apart from the elongate shaft of the endoscope.
 33. The surgicalinstrument assembly of claim 21, the ablation head including a firstsurface that faces toward the elongate shaft of the endoscope and anopposed second surface that faces away from the elongate shaft of theendoscope, the at least one electrode being disposed on the secondsurface.
 34. The surgical instrument assembly of claim 21, the endoscopefurther comprising a handle from which the elongate shaft of theendoscope extends distally, the elongate shaft of the endoscope and thesurgical instrument being rotatable together relative to the handleabout a longitudinal axis defined by the elongate shaft of theendoscope.
 35. A surgical instrument assembly comprising: (a) anendoscope, the endoscope including an elongate shaft having alongitudinal axis and a distal shaft end through which the endoscope isconfigured with a field of view, the field of view encompassing a regionproximal to the distal shaft end; and (b) an ablation instrument fixedlysecured relative to the elongate shaft of the endoscope, the ablationinstrument comprising: (i) a malleable shaft portion, and (ii) anablation head secured to the malleable shaft portion, the ablation headincluding at least one electrode operable to ablate patient tissue. 36.The surgical instrument assembly of claim 35, the at least one electrodecomprising first and second electrodes operable to deliver bipolar RFenergy to tissue.
 37. The surgical instrument assembly of claim 35, aproximal end of the ablation instrument including an electricalconnector configured to releasably couple with an energy source operableto deliver energy to the at least one electrode.
 38. A method ofablating tissue of a patient with a surgical instrument assemblycomprising an endoscope and an ablation instrument, the endoscopedefining a longitudinal axis and including a distal end configured tocapture an image of patient anatomy within a field of view that includesa region that is proximal to the distal end, the ablation instrumentbeing fixedly secured to the endoscope and including a malleable shaftportion and an ablation head having an electrode, the method comprising:(a) inserting the distal end of the endoscope and the ablation head intoa cavity of a patient; (b) under visualization provided by the endoscopevia the field of view, positioning the electrode of the ablation head inelectrical contact with the tissue; and (c) energizing the electrode tothereby ablate the tissue.
 39. The method of claim 38, the ablation headincluding first and second electrodes, ablating the tissue comprisingdelivering bipolar RF energy to the tissue.
 40. The method of claim 38,further comprising bending the malleable shaft portion to position theablation head at a first location relative to the distal end of theendoscope, inserting the distal end of the endoscope and positioning theelectrode of the ablation head each being performed while maintainingthe ablation head at the first location relative to the distal end ofthe endoscope.